NCGNE0767_COMPLETE FILE - HISTORICAL_20150421

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE `O
DOC TYPE
C HISTORICAL FILE
DOC DATE
❑ �� �� �� ��
YYYYM M DD

NCDENR
EwviRo C - —D Nw-va..i RC5oe: S
Division of Water Quality / Surface Water Protection
National Pollutant Discharge Elimination System
ANNUAL NO EXPOSURE EXCLUSION SELF RE -CERTIFICATION
NCGNE0000
Do not submit this form to DWQ unless requested.
For questions, please contact the DWQ Regional Office for your area or the Central Office.
(Please print or type)
Facility's No Exposure Exclusion No. Date Completed (MM/DD/YYYY)
N C G N E 7 6 7 0 4 1 3/ 2 0 1 E
1) Has the facility name or owner changed? ® Yes ❑ No
(if yes, please submit a separate Name/Ownership Change Form to DWQ located at
http:l/portal. ncdenr.oi,g/weblwq/ws/su/n pdessw#Applicalion_Forms_N PDES)
2) Are any of the following materials or activities exposed to precipitation, now or in the foreseeable
future? (Please check either "Yes" or "No.") If you answer "Yes" to any of these items, you are not
eligible to maintain your no exposure exclusion, and must immediately apply for a permit from DWQ.
a. Using, storing, or cleaning industrial machinery or equipment, and areas where ❑ Yes ® No
residuals from using, storing or cleaning industrial machinery or equipment remain
and are exposed to stormwater
b. Materials or residuals on the ground or in stormwater inlets from spills/leaks ❑ Yes ® No
c. Materials or products from past industrial activity
❑ Yes
® No
d. Material handling equipment (except adequately maintained vehicles)
❑ Yes
[:]No
e. Materials or products during loading/unloading or transporting activities
❑ Yes
® No
f. Materials or products stored outdoors (except final products intended for outside
❑ Yes
® No
use [e.g., new cars] where exposure to stormwater does not result in the discharge
of pollutants)
g. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks,
❑ Yes
® No
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by
❑ Yes
® No
the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters])
❑ Yes
® No
j. Applic` Fiw^disposal of process wastewater (unless otherwise permitted)
❑ Yes
® No
RGt`Particu e�cnatter or visible deposits of residuals from roof stacks and/or vents not
❑ Yes
® No
I 4i regulated (i.e., under an air quality control permit) and evident in the
stormwa��pai"iff (I ova
MAD
E R MAD ERW_I N
that previously contained materials that are not properly stored
❑ Yes
® No
�'%R
(i.e., not closed and stored upside down to prevent precipitation accumulation)
Page 1 of 3
SWU-NESR-29Ju12010

NCGNE0000 No Exposure Self Re -Certification
m. For any exterior ASTs, as well as drums, barrels, tanks, and similar containers ❑ Yes ® No
stored outside, has the facility had any releases in the past three (3) years?
3) Above Ground Storage Tanks (ASTs): If you answer "No" to any of the following items, you are not
eligible to maintain your no exposure exclusion, and must immediately apply for a permit from DWQ.
a. Are exterior ASTs and piping free of rust, damaged or weathered coating, pits, or ❑Yes® No ® NIA
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any [:]Yes[:] No ® NIA
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
4) Secondary Containment: If you answer "No" to any of the following items, you are not eligible to
maintain your no exposure exclusion, and must immediately apply for a permit from DWQ.
Is secondary containment provided for all single above ground storage
containers (including drums, barrels, etc.) with a capacity of more than 660-
gallons?
b. Is secondary containment provided for above ground storage containers stored
in close proximity to each other with a combined capacity of more than 1,320-
gallons?
c. Is secondary containment provided for Title III Section 313 Superfund
Amendments and Reauthorization Act (SARA) water priority, chemicals*?
Is secondary containment provided for hazardous substances" designated in 40
CFR §116?
e. Are release valves on all secondary containment structures locked?
Footnotes to Questions 4) C. & d.
❑Yes❑ No ® NIA
[:]Yes[:] No ® NIA
[:]Yes[:] No ® NIA
[:]Yes[—] No ®NIA
❑Yes❑ No ® NIA
*Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require secondary containment
However, some exceptions may be made for de minimis amounts of certain substances, andfor other qualifiers, as described in the
exemptions from reporting requirements of Title III SARA 313 in 40 CFR §372.38.
**Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require secondary containment.
However, some exceptions may be made for amounts less than the Reportable Quantities of the hazardous substances listed in 40 CFR
§117.3.
5) Other information: If you answer "Yes" to any of the following items, and the answer if different from
how it was answered when originally applying, you might not be eligible to maintain your no exposure
exclusion. Please contact the Division if this is the case.
a. Does your facility store used, recycled, or otherwise reclaimed pallets outside?
b. Does your facility have coal piles on site?
c. Does your facility store other fuel sources outside in piles, such as wood chips,
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g.,
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity: Mixing, blending and packaging of minerals and pigments—
e. If you answered yes to d., are those emissions permitted by an Air Quality Permit?
Please specify: NCDER Air Quality Permit No. 09843R01, Facility ID 9000203_
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
��MEM
®Yes[:] No❑NIA
Page 2 of 3
SWU-NESR-29Ju12010

NCGNE0000 No Exposure Self Re -Certification
6) Certification:
I certify under penalty of law that I have read and understand the eligibility requirements for claiming a condition of "no
exposure" and obtaining/maintaining an exclusion from NPDEwS stormwater permitting.
I certify under penalty of law that there are no discharges of stormwater contaminated by exposure to industrial activities
or materials from the industrial facility or site identified in this document (except as allowed under 40 CFR 122.26(g)(2)).
I understand that I am obligated to annually self re -certify No Exposure and, if requested, submit this re -certification to
DWQ or the operator of the local municipal separate storm sewer system (MS4) into which the facility discharges (where
applicable). I understand that I must allow the North Carolina Division of Water Quality, or MS4 operator where the
discharge is into the local MS4, to perform inspections to confirm the condition of no exposure and to make such
inspection reports publicly available upon request.
In the event that the site no longer qualifies for a No Exposure Exclusion, I understand that I must obtain coverage under
an NPDES permit prior to any point source discharge of stormwater from the facility. Additionally, I certify under penalty of
law that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gathered and evaluated the information provided. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the
information, the information provided is to the best of my knowledge and belief true, accurate and complete. I am aware
that there are significant penalties for providing false information, including the possibility of fine and imprisonment for
knowing violations.
I certify that I am familiar with the information contained in this document and that to the best of my knowledge and belief
such information is true, complete, and accurate.
Printed Name of Person Si�Wing:
Title: 1 [ el I or
6,StPwart
(Date
Please note: The Regional Office may inspect your facility at any time in the future for
compliance with the No Exposure Exclusion.
North Carolina General Statute 143-215.6 B(i) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or other
document filed or required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a false
statement of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly
renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
[Environmental Management] Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine
not to exceed ten thousand dollars ($10,000),
This completed form must be kept on file at the facility for at least 5 years. Do not submit this
form to DWQ unless requested.
Page 3 of 3
SWU-NESR-29Jul2010

e NOMA Division of Water Quality / Surface Water Protection
National Pollutant Discharge Elimination System
NCDENR
Resources
"°""`N"�'c`"
= PERMIT NAME/OWNERSHIP CHANGE FORM
-nia°..rncnT —NK��vww
FOR AGENCY USE ONLY
Date Received
Year
Month
Da
I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N 10. 1 $ 10 N j C 10 1 N I E 0 1 7 6 7
IL Permit status rior to requested change.
a. Permit issued to (company name): Prince Minerals Inc.
b. Person legally responsible for permit: Mary Simpler
First M1 Last
c. Facility name (discharge):
d. Facility address:
c. Facility contact person:
SHE Manager
Title
650 Broome Street
Permit Holder Mailing Address
Monroe NC 28110
Ciq' State "Zip
[phone] ( )
Phone Fax
Prince Minerals Inc.
650 Broome Street
Address
Monroe NC 28110
City State Zip
Robert Patterson [phone]
First 1 MI / Last Phone
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: ❑ Change in ownership of the facility
® Name change of the facility or owner
If other please explain:
b. Permit issued to (company name):
c. Person legally responsible for permit
RECEIVED
APR 21 2015
DENR-LAND QUALITY
STORMWATER PERMITTING
d. Facility name (discharge):
e. Facility address:
f. Facility contact person:
Prince Minerals LLC
Craig E Stewart
First M1 Last
Director — Safety, Health, and Environment
Title
650 Broome Street
Permit Holder Mailing Address
Monroe
NC
28110
City
State
Zip
[phone]
[e-mail]
Phone
E-mail Address
Prince Minerals LLC
650 Broome Street
Address
Monroe
NC
28110
City
State
Zip
Robert
Patterson
First MI Last
[phone] atterson @princecorp.com
Phone E-mail Address
Revised 2012Apr23

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
,Page 2 of 2
IV. Permit contact information (if different from the person legally responsible for the permit)
Permit contact:
First MI Last
Title
Mailing Address
City State Zip
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
® Yes
❑ No (please explain)
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
I, Mary Simpler, attest that this application for a name/ownership change has been reviewed and is accurate
and complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
ignature ate
APPLICANT CERTIFICATION
1, Craig Stewart, attest that this application for a name/ownership change has been reviewed and is accurate
and complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all re uired supporting information is not included, this application package will be
returned as incomplete
0 r,
Signature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Revised 7/2008

March 23, 2015
'ro Wham It May Concern:
This is to advise you, that the undersigned, as Chief Financial Officer of Prince Minerals LLC has
authorized, delegated to and appointed Craig Stewart as its agent and representative, to sign, execute and
deliver all applications, permits, licenses, renewals, notices, requests and other documents and
instruments relating to environmental matters for and on behalf of Prince Minerals LLC.
Said authorization and delegation is ongoing and is now in effect and may be relied and acted upon by
you as regards to any environmental applications, permits, requests, notices, licenses or other document or
instrument executed by Craig Stewart as being the duly authorized agent and representative for and by
Prince Minerals LLC.
If you have any questions or concerns, please feel free to contact me.
Kevin C. St. Germaine
Chief Financial Officer
21 West 4611 Street, Fourteenth Floor I New York, NY 10036 j Phone: [phone] www.prineecorp.com

12111LIEN
NC®ENR
North Carolina Department of Environment and Natural
Division of Water Quality
Beverly Eaves Perdue
Governor
Mr. Robert Patterson
Prince Minerals, Inc.
650 Broome Street
Monroe, NC 28110
Dear Mr. Patterson:
Coleen H. Sullins
Director
April 5, 2011
Resources
Subject: No -Exposure Certification NCGNE0767
Prince Minerals, Inc.
650 Broome Street
Union County
Dee Freeman
Secretary
The Division has reviewed your submittal of the No -Exposure Certification form for exclusion from NPDES Stormwater
Permitting. Based on your submittal and signed certification of no -exposure at the above referenced facility, and a site
visit on April 1, 2011 by Mr. Michael Parker with this Office, the Division is granting your conditional exclusion from
stormwater permitting as provided for under 40 CFR 122.26(g), which is incorporated by reference in North Carolina
regulations. Since your facility has attained a No -Exposure exclusion, you will not be required to apply for an NPDES
stormwater permit at this time.
Please note that by our acceptance of your no -exposure certification, you are obligated to maintain no -exposure
conditions at your facility. If conditions change such that your facility can no longer qualify for a No -Exposure
exclusion, you are obligated to immediately obtain NPDES permit coverage for your stormwater discharge. Failure
to obtain a No -Exposure exclusion could also subject you to enforcement for an unpermitted stormwater discharge.
You must self re -certify your No -Exposure status annually using the included form or obtain NPDES permit
coverage for any stormwater discharges from your facility. The annual self re -certification does not need to be
submitted to the Division unless requested. Please note that your conditional exclusion from permitting does not
affect your facility's legal requirements to obtain any other environmental permits that may be required under other
federal, state, or local regulations or ordinances.
If you have any questions or need further information, please contact Mr. Parker at [phone] or by email at
Michael. [e-mail].
Sincerely,
or Coleen H. Sul€ins
cc: Stormwater Permitting Unit, No- Exposure Files (Cory Larsen)
Attachment
Mooresville Regional Office one t 1
Location: 610 EastCenterAve., Suite 301 Mooresville, NC 28115 N�jt1]Cd1011ilc`1
Phone, (704) 663-16991 Fax: {704} 663-60401 Customer Service: 1-877$23-6748 �r��A��r
Internet: www.ncwateNuality.org NaL `J
An Equal Opportunity 1 Affirmative Action Employer - 34% RecycledfW% Post Consumer paper

�t20
NC®ENR
�r.nu.v..r a�Hs, r+.•4,1, trr-,�._�:ra
Division of Water Quality / Surface eater Protection
National Pollutant Discharge Elimination System
NO EXPOSURE CERTIFICATION for Exclusion
NCGNE0000
FOR AGG\CY USE ONLY
Duce Received
Year :Month I Da
Cenilicate or Coverage
NC I GINFQ?tv
RECEIVED
DIVISION OF WATER QUALITY
NO EXPOSURE CERTIFICATION
MAR Q 9 2011
National Pollutant Discharge Elimination System application for exclusion from a Stormwater Permit based
on NO EXPOSURE: _ S+: iP EC T ION
Submission of this No Exposure Certification constitutes notification that your facility does not require a
permit for stormwater discharges associated with industrial activity in the State of North Carolina because
it qualifies for a no exposure exclusion. A condition of no exposure at an industrial facility means all
industrial materials and activities are protected by a storm resistant shelter (with some exceptions) to
prevent exposure to rain, snow, snowmelt, and/or runoff.
For permitted facilities in North Carolina, DWQ must approve your application for No
Exposure Certification before this exclusion is effective. Until you are issued a No
Exposure Certification and your NPDES permit is rescinded, your facility must continue
to abide by the terms and conditions of the current permit.
Industrial materials or activities include, but are not limited to: material handling equipment or activities,
industrial machinery, raw materials, intermediate products, by-products, final products, or waste products.
Material handling activities include the storage, loading and unloading, transportation„ or conveyance of
any raw material, intermediate product, final product or waste product. A storm resistant shelter is not
required for the following industrial materials and activities: drums, barrels, tanks, and similar containers
that are tightly sealed, provided those containers are not deteriorated and do not leak. "Sealed" means
banded or otherwise secured and with locked or non -operational taps or valves; adequately maintained
vehicles used in material handling; and final products, other than products that would be mobilized in
stormwater discharges (e.g., rock salt).
A No Exposure Certification must be provided for each facility qualifying for the no exposure exclusion. In
addition, the exclusion from NPDES permitting is available on a facility -wide basis only —not for individual
outfalls. If any industrial activities or materials are, or will be, exposed to precipitation, the facility is not
eligible for the no exposure exclusion. By signing and submitting this No Exposure Certification form, you
certify that a condition of no exposure exists at this facility or site and are obligated to comply with the
terms and conditions of 40 CFR 122.26(g).
You are required to self re-certifv vour No Exposure Exclusion annually.
For questions, please contact the DWO Regional Office for your area. (See page 6)
1) Mailing address of o
(Please print or type)
erloperator (address to which all certification correspondence will be mailed):
Name
Contact
kc,
Street Address
—
City
�{
Telephone No.
Email Alt
SWU-NE-12Aug2010
V

NCGNE0000 No Exposure Certification
2) Location of facility produ ing discharge:
Facility Name 1
Facility Contact Q C
Facility Street Address cc arl2_
City 1 State ZIP Code
County
Telephone No. - y Fax:
Email �rO�f�CjC1 � f�C't?`
3) Physical location information:
Please provide a narrative description of how to get to�c)vvc>w
e facility (use street names, state ro numbers, and
distance and direction from a roadwa intersection). E
V�-1
(A copy of a map with the facility clearly located on it should be included with the certification application.)
4) Is the facility located on Native American Lands? ❑ Yes IW No
5) Is this a Federal facility? ❑ Yes 9No
6) Latitude ! ggS4QS Longitude �D.�lq'�Cp� (deg., min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
Existing Date operation began
❑ Renewal of existing No Exposure Certification Certification No.: NCGNL
8) Was this facility or site ever covered under an NPDES Stormwater Permit? (71 Yes No
If yes, what is the NPDES Permit Number?
9) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: L2 '?� I
10) Provide a brief description of the types of industrial acrtivities and products produced at this facility:
l
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
Yam!- N o
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
�► s
Page 2 of 7
S W U-NE-12Aug2010

NCGNE0000 No Exposure Certification
Exposure Checklists (12. - 14.)
12) Are any of the following materials or activities exposed to precipitation, now or in the foreseeable
future? (Please check either "Yes" or "No.") If you answer "Yes" to any of these items, you are not
eligible for the no exposure exclusion.
a. Using, storing, or cleaning industrial machinery or equipment, and areas where ❑ Yes � No
residuals from using, storing or cleaning industrial machinery or equipment remain
and are exposed to stormwater
b. Materials or residuals on the ground or in stormwater inlets from spills/leaks ❑ Yes V No
c. Materials or products from past industrial activity 0 Yes LL(No
d. Material handling equipment (except adequately maintained vehicles) Cl Yes IiNo
e. Materials or products during loading/unloading or transporting activities ❑ Yes K No
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes I No
use [e.g., new cars] where exposure to stormwater does not result in the discharge
of pollutants) 11��
g. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, ❑ Yes t94 No
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes �No
the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) ❑ Yes �l No
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes 1�1 No
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes 1� No
otherwise regulated (i.e., under an air quality control permit) and evident in the
stormwater outflow
!. Empty containers that previously contained materials that are not properly stored ❑ Yes Vo
(i.e., not closed and stored upside down to prevent precipitation accumulation)
m. For any exterior ASTs, as well as drums, barrels, tanks, and similar containers ❑ Yes IV No
stored outside, has the facility had any releases in the past three (3) years?
13) Above Ground Storage Tanks (ASTs): If you answer "No" to any of the following items, you are not
eligible for the no exposure exclusion.
a. Are exterior ASTs and piping free of rust, damaged or weathered coating, pits, or Yes ❑ No L7 N/A
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any Yes Cl No ❑ NIA
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
Page 3 of 7
SWU-NE-12Aug2010

NCGNE0000 No Exposure Certification
14) Secondary Containment: 1f you answer "No" to any of the following items, you are not eligible for the
no exposure exclusion.
a. Is secondary containment provided for all single above ground storage
Yes ❑ No
KI NIA
containers (including drums, barrels, etc.) with a capacity of more than 660-
gallons?
A b. Is secondary containment provided for above ground storage containers stored
i Yes ❑ No
flN1A
in close proximity to each other with a combined capacity of more than 1,320-
gallons?
X c. is secondary containment provided for Title III Section 313 Superfund
❑ Yes © No
NIA
Amendments and Reauthorization Act (SARA) water priority chemicals'?
P d. Is secondary containment provided for hazardous substances" designated in 40
❑ Yes D No
'R' N/A
CFR §116?
4 e. Are release valves on all secondary containment structures locked?
❑ Yes ❑ No
f� NIA
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
b. is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste
generated per month) of hazardous waste?
If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste:
How is material stored:
Where is material stored: _
How many disposal shipments per year:
Name of transport / disposal vendor:
Vendor address:
Footnotes to Questions 14) c. & d.
Yes � No
❑ Yes 11 No
❑ Yes 4 No
"Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require
secondary containment. However, some exceptions may be made for de minimis amounts of certain substances,
and/or other qualifiers, as described in the exemptions from reporting requirements of Title III SARA 313 in 40 CFR
§372.38.
"Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require
secondary containment. However, some exceptions may be made for amounts less than the Reportable Quantities
of the hazardous substances listed in 40 CFR §117.3.
Page 4of7
SWU-NE-12Aug2010

NCGNE0000 No Exposure Certification
16) Other information: if you answer "Yes" to any of the following items, you might not be eligible for the
no exposure exclusion. A more in-depth evaluation of the site circumstances may be required.
a. Does your facility store used, recycled, or otherwise reclaimed pallets outside? '0 Yes ❑ No
b. Does your facility have coal piles on site?
0 Yes VNo
c. Does your facility store other fuel sources outside in piles, such as wood chips,
FI Yes V,I No
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g.,
LL t Yes Q No �'\)64- V e,
degreasing operations plating, painting and metal finishing)? If so, describe t e u\(
industrial activity: l� k 1�Q �n�f1C�
p2ov►
tt11 J /
e. If you answered yes to d., are tho a emissions permitted by an Air Quality Permit?
Lft Yes U No 11 NIA
Please specify: 0OiS u 3L00 _
f. Please list any other environmental program permits (federal, state, etc.) not
specified earlier in this application (such as Hazardous Waste Permits, etc.):
Permit: O 3, „OC)_..� , Program: [��� ?PxM'�
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Page 5of7
SW U-NE-12Aug2010

NCGNE0000 No Exposure Certification
17) Certification:
I certify under penalty of law that I have read and understand the eligibility requirements for claiming a condition of "no
exposure" and obtaining an exclusion from NPDES stormwater permitting.
I certify under penalty of law that there are no discharges of stormwater contaminated by exposure to industrial activities
or materials from the industrial facility or site identified in this document (except as allowed under 40 CFR 122.26(g)(2)).
I understand that I am obligated to annually self re -certify No Exposure and, if requested, submft the re -certification to
DWQ or the operator of the local municipal separate storm sewer system (MS4) into which the facility discharges (where
applicable). I understand that I must allow the North Carolina Division of Water Quality, or MS4 operator where the
discharge is into the local MS4, 10 perform inspections to confirm the condition of no exposure and to make such
inspection reports publicly available upon request.
In the event that the site no longer qualifies for a No Exposure Exclusion, I understand that I must obtain coverage under
an NPDES permit prior to any point source discharge of stormwater from the facility. Additionally, I certify under penalty of
law that this document and all attachments were prepared under my direction or supervision in accordance with a system .
designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the
information, the information submitted is to the best of my knowledge and belief true, accurate and complete. I am aware
that there are significant penalties for submitting false information. including the possibility of fine and imprisonment for
knowing violations.
I certify that I am familiar with the information contained in this application and that to the best of my knowledge and belief
such information is true, complete, and accurate.
Printed Name of Person Signing:
Title: l- \t-,, V
u
as
(Signature of Appfica t) T (Date Signed)
Please note: This application for the No Exposure Exclusion is subject to approval by the
NCDENR Regional Office prior to issuance. The Regional Office may inspect your facility for
compliance with no exposure conditions prior to that approval. The Regional Office may also
inspect your facility at any time in the future for compliance with the No Exposure Exclusion.
North Carolina General Statute 143-215.6 B(i) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or other
document filed or required to be maintained under this Article or a rule impiementing this Article; or who knowingly makes a false
statement of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly
renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
[Environmental Management] Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a tine
not to exceed ten thousand dollars ($10,000).
There is currently no fee for a No Exposure Exclusion.
Page 6 of 7
SW U-NE-12Aug2010

NCGNEOOOO No Exposure Certification
Final Checklist
This application should include the following items:
❑ This completed application and all supporting documentation.
❑ A map with the location of the facility clearly marked.
❑ If the site currently has an NPDES Stormwater Permit, be sure to indicate the permit number in Question 8.
Mail the entire package to:
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Note
The submission of this document does not guarantee the issuance of a No Exposure Exclusion.
For questions, please contact the DWQ Regional office for your area.
DWQ Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
807-6300
Page 7 of 7
SWU-NE-12Aug2010

• Latitude and Longitude of a Point
Page 1 of 1
iTouchMap.com
Maps I Country - State I Places I Google Earth I Cities I Earthquakes I I Ain Here I Lat - Long
Home a Latitude and Longitude of a Point
To find the latitude and longitude of a point Click on the map, Drag the marker, or enter the...
Address: 6608roomeStreet Monroe. NC Go'
Map Center. Get Address - Land Plat Size - Street View - Goople Earth 3Q - Area Photoaraohs
Try out the Goodie Earth Plug-in Google Earth gives you a 3D look of the area around the center of the map,
wi is usually your last click point, and includes latitude. longitude and elevation information.
Latitude and Longitude of a Point
Note: Hight click on a blue marker to remove it. Show Point Trotrt Latitude and Longitude
Clear/Reset All Markers_] f_ Center Red Marker Use this if you know the latitude and longitude coordinates of
a point and Want to See where on the map the point is.
Use: + for N Lat or E Long - for S Lat or W Long.
Get the Latitude and Longitude of a Point Example: +40.689060 -74 044636
Note: Your entry should not have any embedded spaces
When you click on the map, move the marker or enter an
address the latitude and longitude coordinates of the point
are inserted in the boxes below
Latitude 34 995445
Longitude -80 49762
Degrees
Minutes
Seconds
Latitude
34
59
43.6014
Longitude
-80
29
51.4314
Decimal Deg. Latitude.
Decimal Deg, Longitude
Show Point
Example +34 40 50.12 for 34N 40' 50 12"
Degrees Minutes Seconds
Latitude:
Longitude:
0tTouchMap com 2007-2010
Show Point
spatial J
http://itouchniap.com/lationg.iitnil
2/22/201'1

3/26/09
Storm Water Permit
I spoke with Mike Parker, Department of Environment and Natural Resources, Division of Water
Quality. After our conversations, the following was concluded.
Prince Minerals facility located at 650 Broome St, Monroe, NC 28110 does not currently quality
for a Storm Water Permit because we do not have a point source discharge of storm water. All
water leaving the facility is listed as sheet run off.
Bob Patterson
Plant Manager